Q&A: Insights on HIV Care, Pharmacists’ Expanding Role

Cassandra Esperant, PharmD, AAHIVP, has made a significant impact on the lives of her patients. Her journey to pharmacy began with a passion for advocacy, which she initially sought to fulfill through a career in law. However, she soon realized that the pharmacy profession offered a unique opportunity to directly improve patient outcomes.

In many states, clinical pharmacists can provide HIV care under collaborative practice agreements. | Image credit: SewcreamStudio - stock.adobe.com

As a credentialed HIV clinical pharmacist with the American Academy of HIV Medicine, Esperant balances direct patient care with public health initiatives. Through social media, she educates on all-things HIV, and as founder and CEO of PrEPRx, she extends her reach through public speaking engagements and consultations.

In her interview with Drug Topics for American Pharmacists Month, Esperant discussed the rewards and challenges of her career, the importance of advocating for provider status, and the value of meeting patients where they are.

Drug Topics: What initially drew you to the pharmacy profession and how has your career path unfolded?

Cassandra Esperant, PharmD, AAHIVP: That's a really good question. I like that question. So, when I was in high school, I actually told my chemistry teacher that I did not need his class because I was going to law school, right? Long and behold, I realized that my heart was a heart of advocacy, and I probably thought that being an attorney [was] the only way [to advocate]. So, when I got to college, I decided to change my profession and started studying pre-pharmacy. But now that I'm in the practice world, I realized that as a clinical pharmacist, we're one of the patient's number one advocates, and I get to kind of channel my attorney hat as well.

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Can you talk about some of the rewards and challenges you face in your practice setting?

Esperant: Some of the rewards that I face in my practice is, as a pharmacist, I have the opportunity to make an impact on each and every one of these patients that I meet. Every patient, I address them differently. So, it could be anything from [having] the opportunity to make sure that that person understands their state of health, and how I interact with them determines how they proceed moving forward. It’s just a great opportunity, meeting them where they are, right?

That's a conversation that we don't have a lot in the clinical field, because even when I'm a patient, I feel vulnerable, and I know how that feels. Having the opportunity to not always have to wear the clinician hat, but to meet them where they are and kind of be a friend, to help them reach their health care goals, is so rewarding to me.

I feel like the [pharmacy] profession is getting ready to leap into a new field when it comes to pharmacy provider status, but we have a lot of barriers. We need reimbursement, and we need a lot of policies to change, to just kind of make that clear that we're able to do that. [We need] all the advocacy that we can get.

Share something unique about your practice setting, patient population, or a specific program you've implemented that exemplifies the value of pharmacists in patient care.

Esperant: As a clinical pharmacist, I have the opportunity to practice under a collaborative practice agreement, and I get to also collaborate with the public health space in the organization. I've had the opportunity to pilot an at-home test kit for pre-exposure prophylaxis [PrEP] for the patients. I have a very small cohort, and that's really rewarding, because I realized that some of these patients may not still be on PrEP if it wasn't for that opportunity to just do the labs at the comfort of your own home and just do everything virtually.

In your opinion, what are the biggest opportunities for pharmacists who expand their role in patient care in today's health care landscape?

Esperant: In terms of expanding our role, I think it's all about the provider status advocacy. That's the number one initiative. And I know we're all divided on that, even as a profession, because we practice in different settings, and for some of us, that will just be an additional role, but I think that we need to advocate in that space and make sure that the policies allow us for the time to learn these things and to implement them. There’s a lot of organizations in a lot of places that have the policies and states, but we don't have the education on how to implement them, so that's so important. The advocacy there and preparation is so vital.

How do you advocate for increased access to HIV medications, PrEP, and other essential resources for your patients in the face of potential barriers like insurance coverage, cost and stigma?

Esperant: One way I advocate is in a social media space. I have an Instagram page called @ThePrEPandHIVPharmacist, where I try to educate about all things HIV prevention. I did mention that I work for an HIV organization, and in that space, I'm able to advocate for different communities that face disparities. [In my] speaker hat, I speak for a couple speaker bureaus and the AIDS Education Training Center, so I'm able to make an impact. I think that if I can reach out to the providers and educate them—because they have influence over all the patients, the leadership in terms of the clinicians—I think that's where it starts, and that will make a major impact.